What is adenomyosis?
It is a condition in which the inner lining of the uterus (the endometrium) bursts through the uterus’s muscle wall, resulting in miscarriage or stillbirth (the myometrium). An adenomyosis patient may suffer from cramps during menstruation, lower abdominal pressure, bloating before menstrual periods, and heavy periods due to the condition. The condition can be found throughout the entire uterus, or it can be found in a single location.
Even though the condition is considered benign (not life-threatening), the frequent pain and heavy bleeding associated with it can negatively impact the overall quality of life for the woman who has it.
How common is adenomyosis?
Because adenomyosis does not always manifest itself in symptoms, many women are unaware that they have the condition. Approximately 20 percent to 65 percent of females may be affected by this condition.
Who might get adenomyosis?
Adenomyosis is a condition that affects many people. It is most commonly diagnosed in middle-aged women and women who have recently given birth to a child. Some research has also suggested that women who have had prior uterine surgery may be at greater risk for developing adenomyosis in the future.
There is currently no known reason for the development of adenomyosis; however, studies have suggested that various hormones, including estrogen, progesterone, prolactin, and follicle-stimulating hormone, may be responsible.
Symptoms of Adenomyosis
Adenomyosis can manifest itself in various ways, including no signs or symptoms or only mild discomfort. Adenomyosis, on the other hand, can result in:
- Heavy or prolonged menstrual bleeding
- Severe cramping or sharp, knifelike pelvic pain during menstruation (dysmenorrhea)
- Chronic pelvic pain
- Painful intercourse (dyspareunia)
Your uterus may grow in size. Even though you may not know a larger uterus, you may experience tenderness or pressure in your lower abdominal area.
Causes of Adenomyosis
The cause of adenomyosis isn’t known. There have been many theories, including:
Invasive tissue growth.
Some experts believe that endometrial cells from the lining of the uterus invade the muscle that forms the uterine walls, resulting in pregnancy complications. According to the research, incisions made in the uterine wall during an operation such as a cesarean section (C-section) may encourage the direct invasion of endometrial cells into the uterine wall.
Other experts believe that endometrial tissue is deposited in the uterine muscle during the fetus’s development of the uterus.
Uterine inflammation related to childbirth.
Another theory proposes a link between adenomyosis and the process of giving birth. Uterine lining inflammation that occurs during the postpartum period may disrupt the usual boundary between the cells that line the uterus.
Stem cell origins.
A recent theory proposes that bone marrow stem cells might invade the uterine muscle, causing adenomyosis.
Regardless of how adenomyosis develops, its growth depends on the body’s circulating estrogen.
Diagnosis of Adenomyosis
To make a definitive diagnosis of adenomyosis until recently, a hysterectomy and examine the uterine tissue under a microscope were the only options available to women. However, advances in imaging technology have made it possible for doctors to diagnose adenomyosis without the need for surgical intervention. Doctors can see the characteristics of the disease in the uterus by using MRI or transvaginal ultrasound technology.
An adenomyosis diagnosis is suspected by a doctor, the first step is to conduct a physical examination. An enlarged and tender uterus may be discovered during a pelvic exam. An ultrasound can provide a clear image of the uterus, including its lining and muscular wall, allowing a doctor to diagnose the condition. Although ultrasound cannot be used to diagnose adenomyosis definitively, it can be used to rule out other conditions with symptoms similar to adenomyosis.
One of the techniques to evaluate adenomyosis symptoms is sonohysterography. Sonohysterography is a procedure in which a saline solution is injected into the uterus while an ultrasound is administered.
It is possible to confirm adenomyosis in women experiencing abnormal uterine bleeding using MRI (magnetic resonance imaging) technology.
Because the symptoms of adenomyosis and uterine fibroids are so similar, adenomyosis is frequently misdiagnosed as uterine fibroids. The two situations, on the other hand, are not the same. In contrast to fibroids, which are benign tumors that grow in or on the uterine wall, adenomyosis is a less well-defined mass of cells that grows within the uterine wall. When it comes to selecting the most appropriate treatment, accuracy is essential.
In addition, there is a requirement that the treatment for adenomyosis be determined by the symptoms you experience, their severity, and whether or not you have finished childbearing. Mild symptoms can be alleviated with over-the-counter pain relievers and the application of a heating pad to relieve cramps if they are severe. Because the female hormone estrogen encourages the growth of endometrial tissue, symptoms of adenomyosis frequently disappear after menopause.
These treatments can help alleviate pain, heavy bleeding, and other symptoms in the meantime; for example,
Anti-inflammatory medications are used to treat inflammation. For mild pain associated with adenomyosis, your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs). Most women begin taking nonsteroidal anti-inflammatory drugs (NSAIDs) one to two days before their period and continue taking them for the first few days of their period.
Hormone therapy is a type of treatment. Aromatase inhibitors, GnRH analogs, and other hormonal therapies can be used to control symptoms such as heavy or painful periods. Levonorgestrel-releasing IUDs (which are inserted into the uterus) are one type of hormonal therapy.
Embolization of the uterine artery. A minimally invasive procedure that is typically used to shrink fibroids, tiny particles are used to block the blood vessels supplying blood to the adenomyosis. The particles are guided through a small tube inserted into the patient’s femoral artery by a radiologist during the procedure. When the adenomyosis’s blood supply is cut off, it shrinks.
Ablation of the endometrium. The lining of the uterus is destroyed during this minimally invasive procedure. Some patients have reported relief from symptoms after having endometrial ablation, which is effective when adenomyosis has not penetrated deeply into the uterus’s muscle wall.
Is adenomyosis a cause of infertility?
In many women with adenomyosis, endometriosis also occurs, so it is difficult to determine the precise role of adenomyosis in infertility complications. However, some research has indicated that adenomyosis may be a contributing factor to infertility.
What are the complications of adenomyosis?
You are more likely to develop anemia if you have heavy menstrual bleeding due to adenomyosis. Anemia occurs when your body does not have enough iron-rich red blood cells to carry oxygen throughout your body. You might be experiencing chronic fatigue or a cold.
Having prolonged, heavy bleeding during your periods regularly increases your risk of developing chronic anemia, which can lead to fatigue and other health problems. Although adenomyosis is not harmful, the pain and excessive bleeding associated with it can make it challenging to live an everyday life. You might avoid activities that you’ve enjoyed in the past because you’re in pain or because you’re concerned that you’ll bleed out of your wound.
Adenomyosis is associated with several risk factors, including:
- Prior uterine surgery, such as C-section, fibroid removal, or dilatation and curettage (D&C)
- Middle age
It is most common in women in their forties and fifties who develop the condition caused by the presence of estrogen. The presence of adenomyosis in these women may be related to their exposure to estrogen for a more extended period than younger women. On the other hand, current research suggests that the condition may also be prevalent among younger women.
How does adenomyosis affect pregnancy?
Women who have had at least one child are more likely to be affected by adenomyosis. The condition may make it difficult when attempting to conceive for the first time or having another child. Infertility treatments may be of assistance. When you become pregnant, you run a higher risk of developing:
- Miscarriage (loss of pregnancy before a baby fully develops).
- Premature labor (childbirth before the 37th week of pregnancy).
You may be unaware that you have adenomyosis. Symptoms of the condition do not always manifest themselves. When symptoms such as heavy periods, cramping, or painful intercourse appear, they can cause significant disruption in your life. Consult with Dr. Morris at the BRISBANE CENTRE FOR ENDOMETRIOSIS for advice on how to manage your symptoms. Certain hormonal medications may be of assistance. If you do not intend to have children, a hysterectomy (removal of the uterus) may be necessary to correct the problem. After menopause, the symptoms subside.